Prospective associations of occupational and leisure-time physical activity with risk of diabetes: a cohort study from the United States.

OBJECTIVES: Leisure-time physical activity (LTPA) can reduce the risk of incident diabetes, whereas the role of occupational physical activity (OPA) in developing diabetes is still unclear due to conflicting evidence. Moreover, the joint associations of OPA and LTPA with incident diabetes among US workers have not yet been systematically examined. The objective of this study was to assess the independent and joint associations of OPA and LTPA with incident diabetes. METHODS: This prospective cohort study included 1406 workers free from diabetes at baseline (2004-2006) from the national, population-based Mid-life in the United States (MIDUS) study. Associations of OPA and LTPA at baseline with incident diabetes during 9 years of follow-up were examined using Poisson regression models. High OPA was defined based on engagement in physical demands at work, and high LTPA was defined as participation in moderate or vigorous LTPA at least once per week. RESULTS: High OPA was associated with an increased risk of diabetes compared to low OPA (adjusted risk ratios and 95% confidence interval = 1.52 [1.04, 2.22]), while high LTPA was associated with a decreased risk of diabetes compared to low LTPA (0.66 [0.44, 0.97]). Diabetes risk was the highest among workers with high OPA and low LTPA (2.30 [1.30, 4.07]). CONCLUSIONS: In a national, population-based prospective cohort study of US workers, high OPA was associated with an elevated risk of diabetes, while high LTPA was associated with a decreased diabetes risk. The combination of high OPA and low LTPA exhibited the greatest risk of diabetes.

Formulations of Job Strain and Psychological Distress: A Four-year Longitudinal Study in Japan.

Background: Different job strain formulations based on the Job Demand-Control model have been developed. This study evaluated longitudinal associations between job strain and psychological distress and whether associations were influenced by six formulations of job strain, including quadrant (original and simplified), subtraction, quotient, logarithm quotient, and quartile based on quotient, in randomly selected Japanese workers. Methods: Data were from waves I and II of the Survey of Midlife in Japan (MIDJA), with a 4-year follow-up period. The study sample consisted of 412 participants working at baseline and had complete data on variables of interest. Associations between job strain at baseline and psychological distress at follow-up were assessed via multivariable linear regression, and results were expressed as ß coefficients and 95% confidence intervals including R2 and Akaike information criterion (AIC) evaluation. Results: Crude models revealed that job strain formulations explained 6.93-10.30% of variance. The AIC ranged from 1475.87 to 1489.12. After accounting for sociodemographic and behavioral factors and psychological distress at baseline, fully-adjusted models indicated significant associations between all job strain formulations at baseline and psychological distress at follow-up: original quadrant (ß: 1.16, 95% CI: 0.12, 2.21), simplified quadrant (ß: 1.01, 95% CI: 0.18, 1.85), subtraction (ß: 0.39, 95% CI: 0.09, 0.70), quotient (ß: 0.37, 95% CI: 0.08, 0.67), logarithm quotient (ß: 0.42, 95% CI: 0.12, 0.72), and quartile based on quotient (ß: 1.22, 95% CI: 0.36, 2.08). Conclusion: Six job strain formulations showed robust predictive power regarding psychological distress over 4 years among Japanese workers.

The socioeconomic consequences of loneliness: Evidence from a nationally representative longitudinal study of young adults.

The negative health consequences of loneliness have led to increasing concern about the economic cost of loneliness in recent years. Loneliness may also incur an economic burden more directly, by impacting socioeconomic position. Much of the research to date has focused on employment status which may not fully capture socioeconomic position and has relied on cross-sectional data, leaving questions around the robustness of the association and reverse causation. The present study used longitudinal data to test prospective associations between loneliness and multiple indicators of social position in young adulthood, specifically, whether participants who were lonelier at age 12 were more likely to be out of employment, education and training (NEET) and lower on employability and subjective social status as young adults. The data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 individuals born in England and Wales during 1994-1995. Loneliness and subjective social status were measured at ages 12, 18 and 26. Employability and NEET status were assessed at age 18. Findings indicate that greater loneliness at age 12 was prospectively associated with reduced employability and lower social status in young adulthood. The association between loneliness and lower social status in young adulthood was robust when controlling for a range of confounders using a sibling-control design. Results also indicate that loneliness is unidirectionally associated with reduced subjective social status across adolescence and young adulthood. Overall, our findings suggest that loneliness may have direct costs to the economy resulting from reduced employability and social position, underlining the importance of addressing loneliness early in life.

Social isolation, loneliness, and inflammation: A multi-cohort investigation in early and mid-adulthood.

Social isolation and loneliness have been associated with poor health and increased risk for mortality, and inflammation might explain this link. We used data from the Danish TRIAGE Study of acutely admitted medical patients (N = 6,144, mean age 60 years), and from two population-representative birth cohorts: the New Zealand Dunedin Longitudinal Study (N = 881, age 45) and the UK Environmental Risk (E-Risk) Longitudinal Twin Study (N = 1448, age 18), to investigate associations of social isolation with three markers of systemic inflammation: C-reactive protein (CRP), interleukin-6 (IL-6), and a newer inflammation marker, soluble urokinase plasminogen activator receptor (suPAR), which is thought to index systemic chronic inflammation. In the TRIAGE Study, socially isolated patients (those living alone) had significantly higher median levels of suPAR (but not CRP or IL-6) compared with patients not living by themselves. Social isolation prospectively measured in childhood was longitudinally associated with higher CRP, IL-6, and suPAR levels in adulthood (at age 45 in the Dunedin Study and age 18 in the E-Risk Study), but only suPAR remained associated after controlling for covariates. Dunedin Study participants who reported loneliness at age 38 or age 45 had elevated suPAR at age 45. In contrast, E-Risk Study participants reporting loneliness at age 18 did not show any elevated markers of inflammation. In conclusion, social isolation was robustly associated with increased inflammation in adulthood, both in medical patients and in the general population. It was associated in particular with systemic chronic inflammation, evident from the consistently stronger associations with suPAR than other inflammation biomarkers.

Adverse Childhood Experiences, Social Isolation, Job Strain, and Cardiovascular Disease Mortality in U.S. Older Employees.

Stress is a key driver of cardiovascular disease (CVD), yet the contribution of psychosocial stressors to the development of CVD has not been systematically examined in United States (U.S.) populations. The objective of this study was to assess prospective associations of adverse childhood experiences (ACEs), social isolation, and job strain with CVD mortality. Data were from the large, nationally representative, population-based Health and Retirement Study (HRS). ACEs, social isolation and job strain were assessed using validated survey instruments at baseline between 2006-2008, and death information was followed up through 2018. Cox proportional hazards regression models were used to examine prospective associations of ACEs, social isolation, and job strain with CVD mortality among 4046 older employees free from CVD at baseline. During 42,149 person-years of follow-up time, 59 death cases of CVD were reported. After adjustment for covariates, ACEs and job strain were significantly associated with increased risk of CVD mortality (aHR and 95% CI = 3.67 [1.59, 8.48] and 2.24 [1.21, 4.11], respectively), whereas social isolation demonstrated an inflated but nonsignificant association (aHR and 95% CI = 1.62 [0.72, 3.66]). These findings highlight the role of psychosocial exposures as novel and clinically relevant risk factors for CVD.

Social isolation from childhood to mid-adulthood: is there an association with older brain age?

BACKGROUND: Older brain age - as estimated from structural MRI data - is known to be associated with detrimental mental and physical health outcomes in older adults. Social isolation, which has similar detrimental effects on health, may be associated with accelerated brain aging though little is known about how different trajectories of social isolation across the life course moderate this association. We examined the associations between social isolation trajectories from age 5 to age 38 and brain age assessed at age 45. METHODS: We previously created a typology of social isolation based on onset during the life course and persistence into adulthood, using group-based trajectory analysis of longitudinal data from a New Zealand birth cohort. The typology comprises four groups: 'never-isolated', 'adult-only', 'child-only', and persistent 'child-adult' isolation. A brain age gap estimate (brainAGE) - the difference between predicted age from structural MRI date and chronological age - was derived at age 45. We undertook analyses of brainAGE with trajectory group as the predictor, adjusting for sex, family socio-economic status, and a range of familial and child-behavioral factors. RESULTS: Older brain age in mid-adulthood was associated with trajectories of social isolation after adjustment for family and child confounders, particularly for the 'adult-only' group compared to the 'never-isolated' group. CONCLUSIONS: Although our findings are associational, they indicate that preventing social isolation, particularly in mid-adulthood, may help to avert accelerated brain aging associated with negative health outcomes later in life.

Prediction of in-hospital deterioration in normotensive pulmonary embolism remains elusive: external validation of the calgary acute pulmonary embolism score.

Acute pulmonary embolism (PE) is a frequently diagnosed condition. Prediction of in-hospital deterioration is challenging with current risk models. The Calgary Acute Pulmonary Embolism (CAPE) score was recently derived to predict in-hospital adverse PE outcomes but has not yet been externally validated. Retrospective cohort study of normotensive acute pulmonary embolism cases diagnosed in our emergency department between 2017 and 2019. An external validation of the CAPE score was performed in this population for prediction of in-hospital adverse outcomes and a secondary outcome of 30-day all-cause mortality. Performance of the simplified Pulmonary Embolism Severity Index (sPESI) and Bova score was also evaluated. 712 patients met inclusion and exclusion criteria, with 536 patients having a sPESI score of 1 or more. Among this population, the CAPE score had a weak discriminative power to predict in-hospital adverse outcomes, with a calculated c-statistic of 0.57. In this study population, an external validation study found weak discriminative power of the CAPE score to predict in-hospital adverse outcomes among normotensive PE patients. Further efforts are needed to define risk assessment models that can identify normotensive PE patients at risk for in hospital deterioration. Identification of such patients will better guide intensive care utilization and invasive procedural management of PE.

Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort.

Objective: This study examined longitudinal associations between attention-deficit/hyperactivity disorder (ADHD) symptoms and social isolation across childhood. The study tested the direction of this association across time, while accounting for preexisting characteristics, and assessed whether this association varied by ADHD presentation, informant, sex, and socioeconomic status. Method: Participants included 2,232 children from the Environmental Risk (E-Risk) Longitudinal Twin Study. ADHD symptoms and social isolation were measured at ages 5, 7, 10, and 12. Random-intercept cross-lagged panel models were used to assess the directionality of the association across childhood. Results: Children with increased ADHD symptoms were consistently at increased risk of becoming socially isolated later in childhood, over and above stable characteristics (ß = .05-.08). These longitudinal associations were not bidirectional; isolated children were not at risk of worsening ADHD symptoms later on. Children with hyperactive ADHD presentation were more likely to become isolated, compared with inattentive presentation. This was evident in the school setting, as observed by teachers, but not by mothers at home. Conclusion: The study findings highlight the importance of enhancing peer social support and inclusion for children with ADHD, particularly in school settings. This study adds explanatory value beyond traditional longitudinal methods, as the results represent how individual children change over time, relative to their own preexisting characteristics. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Problematic technology use and sleep quality in young adulthood: novel insights from a nationally representative twin study.

STUDY OBJECTIVES: Digital technology use is associated with poor sleep quality in adolescence and young adulthood although research findings have been mixed. No studies have addressed the association between the two using a genetically informative twin design which could extend our understanding of the etiology of this relationship. This study aimed to test: (1) the association between adolescents' perceived problematic use of digital technology and poor sleep quality, (2) whether the association between problematic use of technology and poor sleep quality remains after controlling for familial factors, and (3) genetic and environmental influences on the association between problematic use of technology and poor sleep quality. METHODS: Participants were 2232 study members (18-year-old twins) of the Environmental Risk (E-Risk) Longitudinal Twin Study. The sample was 48.9% male, 90% white, and 55.6% monozygotic. We conducted regression and twin difference analyses and fitted twin models. RESULTS: Twin differences for problematic use of technology were associated with differences for poor sleep quality in the whole sample (p < 0.001; B = 0.15) and also when we limited the analyses to identical twins only (p < 0.001; B = 0.21). We observed a substantial genetic correlation between problematic use of technology and sleep quality (rA = 0.31), whereas the environmental correlation was lower (rE = 0.16). CONCLUSIONS: Adolescent reported problematic use of digital technology is associated with poor sleep quality-even after controlling for familial factors including genetic confounds. Our results suggest that the association between adolescents' sleep and problematic digital technology use is not accounted for by shared genetic liability or familial factors but could reflect a causal association. This robust association needs to be examined in future research designed to test causal associations.

Workplace Discrimination and Risk of Hypertension: Findings From a Prospective Cohort Study in the United States.

Background Mounting evidence has demonstrated a role of psychosocial stressors such as discrimination in hypertension and cardiovascular diseases. The objective of this study was to provide the first instance of research evidence examining prospective associations of workplace discrimination with onset of hypertension. Methods and Results Data were from MIDUS (Midlife in the United States), a prospective cohort study of adults in the United States. Baseline data were collected in 2004 to 2006, with an average 8-year follow-up period. Workers with self-reported hypertension at baseline were excluded, yielding a sample size of 1246 participants for the main analysis. Workplace discrimination was assessed using a validated 6-item instrument. During follow-up with 9923.17 person-years, 319 workers reported onset of hypertension, and incidence rates of hypertension were 25.90, 30.84, and 39.33 per 1000 person-years among participants with low, intermediate, and high levels of workplace discrimination, respectively. Cox proportional hazards regression analyses demonstrated that workers who experienced high exposure to workplace discrimination, compared with workers with low exposure, had a higher hazard of hypertension (adjusted hazard ratio, 1.54 [95% CI, 1.11-2.13]). Sensitivity analysis excluding more baseline hypertension cases based on additional information on blood pressure plus antihypertensive medication use (N=975) showed slightly stronger associations. A trend analysis showed an exposure-response association. Conclusions Workplace discrimination was prospectively associated with elevated risk of hypertension among US workers. The adverse impacts of discrimination on cardiovascular disease have major implications for workers' health and indicate a need for government and employer policy interventions addressing discrimination.

Comparison of colour contrast sensitivity in eyes at high risk of neovascular age-related macular degeneration with and without subsequent choroidal neovascular membrane development.

BACKGROUND: Neovascular age-related macular degeneration (nAMD) is a leading cause of blind registrations in the elderly. Unfortunately, it is difficult to detect the early stage of the disease, when treatment is more likely to be successful. Subjects with very early disease are likely to have abnormal macular function, even in the pre-symptomatic stage. In this study, colour vision was evaluated to establish if subjects at high risk of developing nAMD can be identified, thus allowing earlier diagnosis and possible treatment. METHODS: Colour contrast sensitivity (CCS) was evaluated over time in the fellow unaffected eye of subjects with unilateral nAMD. Participants were divided into Group 1 (182 participants) or Group 2 (15 participants) according to whether nAMD did not or did develop in the study period respectively and the two groups were compared. RESULTS: CCS was increased (i.e. worse colour vision) compared with the age-matched reference range in a high proportion of fellow eyes in both Groups 1 and 2. Global mean CCS values did not show statistically significant differences between the two groups. However, there was a statistically significant difference between mean Group 1 CCS values and the last CCS value prior to nAMD diagnosis from Group 2 subjects. CONCLUSION: This study shows that in patients with unilateral nAMD, colour vision is frequently abnormal in the fellow unaffected eye. Abnormal CCS does not predict the development of nAMD within the 12 month period of the study and therefore it is not a viable screening tool for this pathology.

The developmental course of loneliness in adolescence: Implications for mental health, educational attainment, and psychosocial functioning.

The present study examined patterns of stability and change in loneliness across adolescence. Data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a UK population-representative cohort of 2,232 individuals born in 1994 and 1995. Loneliness was assessed when participants were aged 12 and 18. Loneliness showed modest stability across these ages (r = .25). Behavioral genetic modeling indicated that stability in loneliness was explained largely by genetic influences (66%), while change was explained by nonshared environmental effects (58%). Individuals who reported loneliness at both ages were broadly similar to individuals who only reported it at age 18, with both groups at elevated risk of mental health problems, physical health risk behaviors, and education and employment difficulties. Individuals who were lonely only at age 12 generally fared better; however, they were still more likely to finish school with lower qualifications. Positive family influences in childhood predicted reduced risk of loneliness at age 12, while negative peer experiences increased the risk. Together, the findings show that while early adolescent loneliness does not appear to exert a cumulative burden when it persists, it is nonetheless a risk for a range of concomitant impairments, some of which can endure.

Increased job strain and cardiovascular disease mortality: a prospective cohort study in U.S. workers.

Job strain is considered a potential risk factor of cardiovascular disease (CVD). Our objective was to examine prospective associations of job strain with CVD mortality using data from the national, population-based Mid-life in the United States (MIDUS) cohort study, while considering changes in job strain. Job strain measure was based on Demand-Control model at Wave 1 in 1995-1996 and Wave 2 in 2004-2006, and CVD mortality data through 2018 were retrieved through linkage to the National Death Index (NDI). Cox proportional hazards regression was applied to assess prospective associations between job strain across MIDUS I and MIDUS II and CVD mortality at follow-up in 1,870 workers free from CVD at MIDUS I. After adjustment for relevant covariates, single measurement of job strain at MIDUS I or MIDUS II, and two measurements of job strain between the two waves were not significantly associated with CVD mortality, while the increase in scores between the two waves (increase vs. no increase) demonstrated stronger prospective associations with CVD mortality (HR and 95% CI = 2.37 [0.88, 6.42]). Our findings suggest increased job strain may pose a stronger risk to CVD mortality than single exposure measurement.

Are trajectories of social isolation from childhood to mid-adulthood associated with adult depression or suicide outcomes.

PURPOSE: Social isolation has been shown to have negative effects on mental health outcomes though little is known about trajectories across the life course. We examined the relationship between trajectory groups and selected mental health outcomes in mid-adulthood. METHODS: We previously created a typology of social isolation based on onset during the life course and persistence into adulthood, using group-based trajectory analysis of longitudinal data from a New Zealand birth cohort. The typology comprises four groups: 'never-isolated', 'adult-only', 'child-only', and 'persistent (child-adult) isolation'. We undertook logistic regression analyses of three mental health outcomes with trajectory group as the predictor, adjusting for sex and a range of familial and child-behavioural factors. RESULTS: Lifetime suicide attempt, and depression and suicide ideation in mid-adulthood were each associated with adult-only but not child-only social isolation. Depression in mid-adulthood was also associated with persistent child-adult social isolation. CONCLUSION: Although our findings are associational and not causal, they indicate that interrupting persistent social isolation may help to prevent adult depression whereas halting adult social isolation may ameliorate both depression and suicide outcomes.

Unrewarding work and major depressive episode: Cross-sectional and prospective evidence from the U.S. MIDUS study.

Depression is a serious mental health condition and is the leading cause of disability worldwide. Previous research has demonstrated that work stress may contribute to the development of depression through psychophysiological pathways. The present study assessed associations of work stress - in terms of the effort-reward imbalance (ERI) model measuring unrewarding work - with major depressive episode (MDE). Data were from the Mid-life in the United States study, a national, population-based sample of U.S. workers with 9-year follow-up prospective cohort design. The cross-sectional sample at baseline had 2204 workers, and the prospective sample had 1591 workers at follow-up (78.7% follow-up rate). Multivariable Bayesian logistic regression and Poisson regression were applied for examining cross-sectional and prospective associations, respectively. ERI was assessed by a validated 17-item scale at baseline, and MDE in the past 12 months was assessed by the Composite International Diagnostic Interview Short Form at both baseline and follow-up. It was found that ERI at baseline was associated with higher odds of prevalent MDE in the cross-sectional sample (OR = 1.47, HPD interval [1.26-1.69]), and with higher risk of MDE at follow-up in the prospective sample (RR = 1.29, HPD interval [1.01-1.60]). In both cross-sectional and prospective analyses, strongest associations were observed among workers with the highest quartile of ERI, after adjusting for demographic, socioeconomic, lifestyle, and other psychosocial factors. The stable and robust findings strengthen and extend previous findings that unrewarding work is a risk factor of mental health. If confirmed by further evidence, intervention targeting work stress reduction is warranted.

Adulthood Psychosocial Disadvantages and Risk of Hypertension in U.S. Workers: Effect Modification by Adverse Childhood Experiences.

Hypertension is a key driver of cardiovascular diseases. However, how stressors contribute to the development of hypertension remains unclear. The objective of this study was to examine prospective associations of adverse childhood experiences (ACEs) and adulthood psychosocial disadvantages (APDs) with incident hypertension. Data were from the Mid-life in the United States (MIDUS) study, a national, population-based, prospective cohort study. ACEs were examined via retrospective reports, and APDs including work stress and social isolation were assessed using survey measures. Incident hypertension was defined based on self-reported physician diagnosis. Baseline data were collected in 1995, with follow-up in 2004-2006 and 2013-2014. Cox proportional hazards regression was applied to assess prospective associations of ACEs and APDs with incident hypertension in 2568 workers free from hypertension at baseline. After adjustment for covariates, baseline APDs were associated with increased incident hypertension (aHR and 95% CI = 1.48 [1.09, 2.01]) during a 20-year follow-up, whereas ACEs showed null associations. Moreover, a moderating effect by ACEs was observed-the effect of APDs on risk of hypertension was stronger when ACEs were present (aHR and 95% CI = 1.83 [1.17, 2.86]). These findings underscore the importance of psychosocial stressors as nontraditional risk factors of cardiometabolic disorders.

The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study.

OBJECTIVES: Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension. METHODS: This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week. RESULTS: During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43). CONCLUSIONS: Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.

Gender difference in working from home and psychological distress - A national survey of U.S. employees during the COVID-19 pandemic.

The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work. While the general subject of working from home has recently drawn increased attention, few studies have assessed gender differences in vulnerability to the potential mental health effects of working from home. Using data from 1,585 workers who participated in the Health, Ethnicity, and Pandemic (HEAP) study, a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020, associations of working from home with psychological distress were examined with weighted logistic regression among 1,585 workers and stratified by gender. It was found that workers who worked from home had higher odds of psychological distress (aOR and 95% CI = 2.62 [1.46, 4.70]) compared to workers who did not work from home, adjusting for demographic factors, socioeconomic status, and health behaviors. In gender-stratified analyses, this positive association between working from home and psychological distress was significant in women (aOR and 95% CI = 3.68 [1.68, 8.09]) but not in men. These results have implications for female workers' mental health in the transition towards working from home in the COVID-19 pandemic era.

Associations of employment status with opioid misuse: Evidence from a nationally representative survey in the U.S.

The opioid crisis in the United States (U.S.) is widespread and increasing in severity, and psychosocial exposures have been identified as potential risk factors. We examined associations of employment status with opioid misuse in a large, nationally representative, population-based sample in the U.S. Data were from the 2019 National Survey of Drug Use and Health (NSDUH), an annual cross-sectional survey. The association of employment status with opioid misuse in 40,143 participants was examined by multivariable logistic regression, adjusting for age, sex, race/ethnicity, marital status, household income, educational attainment, medical insurance status, physical health conditions and depression. Analyses were weighted to represent a nationally representative sample of adults in the U.S. In NSDUH 2019, 3.82% of American individuals reported past-year opioid misuse. After taking relevant variables into account, compared to workers who were employed with normal working hours (35-40 h/week), those who were currently unemployed had higher odds of opioid misuse (fully adjusted odds ratio and 95% confidence interval were 1.40 [1.09, 1.79]). Compared to workers employed with normal working hours, those who were in school/training or retired had lower odds of opioid misuse. Short or long working hours were not associated with opioid misuse. Government and employer policy interventions may benefit from emphasizing stable employment as a major social determinant of health in the context of the opioid crisis.

Using a Loneliness Measure to Screen for Risk of Mental Health Problems: A Replication in Two Nationally Representative Cohorts.

BACKGROUND: Loneliness co-occurs alongside many mental health problems and is associated with poorer treatment outcomes. It could therefore be a phenomenon of interest to clinicians as an indicator of generalised risk for psychopathology. The present study tested whether a short measure of loneliness can accurately classify individuals who are at increased risk of common mental health problems. METHODS: Data were drawn from two nationally representative cohorts: the age-18 wave of the UK-based Environmental Risk (E-Risk) Longitudinal Twin Study and the age-38 wave of the New Zealand-based Dunedin Multidisciplinary Health and Development Study. In both cohorts, loneliness was assessed using the three-item UCLA Loneliness Scale, plus two stand-alone items about feeling alone and feeling lonely. Outcome measures consisted of diagnoses of depression and anxiety and self-reports of self-harm/suicide attempts, assessed via a structured interview. RESULTS: ROC curve analysis showed that the Loneliness Scale had fair accuracy in classifying individuals meeting criteria for all three outcomes, with a cut-off score of 5 (on a scale from 3 to 9) having the strongest empirical support. Both of the stand-alone items showed modest sensitivity and specificity but were more limited in their flexibility. The findings were replicated across the two cohorts, indicating that they are applicable both to younger and older adults. In addition, the accuracy of the loneliness scale in detecting mental health problems was comparable to a measure of poor sleep quality, a phenomenon which is often included in screening tools for depression and anxiety. CONCLUSIONS: These findings indicate that a loneliness measure could have utility in mental health screening contexts, as well as in research.